Otolaryngology Coding Alert

Question: After performing a sinus surgery, an otolaryngologist examines the inside of each maxillary sinus. The access was made during surgery. Can I bill the in-office examination by appending modifier 52 to 31233?


Missouri Subscriber


Answer: You do not need to use modifier 52 (Reduced services). Code 31233 (Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy [via inferior meatus or canine fossa puncture]) does not represent making the access. The code describes a diagnostic endoscopy in the maxillary sinuses. The otolaryngologist can perform the endoscopy by:

1. making a puncture

2. using windows that a physician previously created.

Key: When a patient is open into the maxillaries and the otolaryngologist performs a medically necessary diagnostic endoscopy all the way into the maxillaries, he should use 31233.

Don't forget: If the physician performs the endoscopy bilaterally, you should report 31233 bilaterally by appending the code with modifier 50 (Bilateral procedure). Unlike 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]), 31233 is not a unilateral or bilateral code and when performed bilaterally is appended with modifier 50.

Also: The same endoscopy and modifier guidelines apply to 31235 (Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy [via puncture of sphenoidal face or cannulation of ostium]). But you won't frequently use this code. Patients are rarely open into the sphenoids, so otolaryngologists do not often examine them in the office diagnostically.